23B-046 BP-2020-0906
30 LOCUST ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23B-046-001 CITY OF NORTHAMPTON
Permit: renovation
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2020-0906 PERMISSION'S HEREBY GRANTED TO:
Project# JS-2020-001541 Contractor: License:
Est. Cost: 2276958.00 RAYMOND R HOULE CONST INC
Const.Class: Exp.Date:
Use Group: Owner: COOLEY DICKINSON HOSPITAL INC
Lot Size(sq.ft.)
Zoning: M/WP Applicant: RAYMOND R HOULE CONST INC
Applicant Address Phone: Insurance:
5 MILLER ST (413)547-2500 0 WBN-D733095
LUDLOW, MA 01056
ISSUED ON:02/14/2020
TO PERFORM THE FOLLOWING WORK:
RENOVATIONS TO CHILDBIRTH CENTER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
6 ._2-
Final: 7 Final: (, ,c9.,� �3 Final: Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:Oil -Z3 K l N
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 4.411141684
Fees Paid: $15,400.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
[Type ;Rh,'
Y, *-AO Commonwealth of Massachusetts Citfill
City of Northampton
of Occup
ancy
Certificate anc
fp y
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
Ra mond R Houle Construction Inc. BP-2020-0906
Y Childbirth rooms
Cooley Dickinson Hospital Inc. 8-9-10 only
Identify property address including street number, name, city or town and county
Located at
30 Locust St.
Northampton, Hampshire, Massachusetts
Use Group
Classification(s) I - 2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural,Means of Egress and Life Safety systems must be maintained.
Name of Municipal Date of Final Map/Plot:
Building Official Kevin Ross Inspection 01/07/2022
Signature of Municipal t Date of 23B-046
Building Official / Issuance 01/07/2022
[Type ,
*Ail (2The Commonwealth of Massachusetts
City of Northampton
Certificate of Occupancy
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
Ra mond R Houle Construction Inc. BP-2020-0906
Y Childbbirthirth r r0000ms
Cooley Dickinson Hospital Inc. 13-14-15-16
Tub room and
visitors bathroom
Identify property address including street number, name, city or town and county
Located at
30 Locust Street
Northampton, Hampshire, Massachusetts
Use Group
Classification(s) I - 2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural, Means of Egress and Life Safety systems must be maintained.
Name of Municipal Date of Final Map/Plot:
Building Official Kevin Ross Inspection 04/22/2022
Signature of Municipal Date of 23B-046
Building Official ` Issuance 04/22/2022
Type~ '?h.', 4-10 fir
The Commonwealth of Massachusetts
t City of Northampton
Certificate f of Occupancy
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
Raymond R Houle Construction Inc. BP Zo2o o9oh
Cooley Dickinson Hospital Inc.
Identify property address including street number, name, city or town and county
Located at
30 Locust Street Childbirth Rooms
Northampton, Hampshire, Massachusetts 5-6-7
Use Group
Classification(s) I-2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural,Means of Egress,Life safety and Sprinkler systems must be maintained.
Name of Municipal Kevin Ross Date of Final Map/Plot:
Building Official Inspection 08/12/2022
Signature of Municipal / Date of 23B-046
Building Official Issuance 08/12/2022
[Type '6'
* The Commonwealth of Massachusetts }AA
,;
t1 •J City of Northampton
of Occup
ancy
Certificate anc
fp y
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
Raymond R Houle Construction Inc. BP-2020-0906
Cooley Dickinson Hospital Inc.
Identify property address including street number, name, city or town and county
Located at
30 Locust Strret Childbirth Rooms
Northampton, Hampshire, Massachusetts 1-2
Use Group
Classification(s) I - 2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural,Means of Egress,Life safety and Sprinkler systems must be maintained.
Name of Municipal KeV. Ross Date of Final Map/Plot:
Building Official Inspection 10/28/2022
Signature of Municipal /7 ,v Date of 23B-046
Building Official �` Issuance 10/28/2022
[Type l
�r
* The Commonwealth of Massachusetts }�z,��:-
t City of Northampton ,
i Certificate of Occupancy
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
BP-2020-0906
Raymond R Houle Construction Inc.
Cooley Dickinson Hospital Inc.
Identify property address including street number, name, city or town and county
Located at
30 Locust Strret Childbirth Rooms
Northampton, Hampshire, Massachusetts 3-4
Use Group
Classification(s) I - 2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural, Means of Egress, Life safety and Sprinkler systems must be maintained.
Name of Municipal Date of Final Map/Plot:
Building Official Kevin Ross Inspection 01/13/2023
Signature of Municipal iDate of 23B-046
Building Official / y•--------7
Issuance 01/13/2023
[Type h! w ����
* The Commonwealth of Massachusetts � ,
ZE � �
City of Northampton
Certificate of Occupancy
a n
p cy
In accordance with 780 CMR, (The 9th Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
BP-2020-0906
Raymond R Houle Construction Inc.
Cooley Dickinson Hospital Inc.
Identify property address including street number, naive, city or town and county
Located at
30 Locust Street Final on all phases
Northampton, Hampshire, Massachusetts Job complete
Use Group
Classification(s) I - 2
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or,tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Structural,Means of Egress,Life safety and Sprinkler systems must be maintained.
Name of Municipal Date of Final Map/Plot:
Building Official Kevin Ross Inspection 07/07/2023
Signature of Municipal f Date of 23B-046
Building Official / Issuance 07/07/2023
PROJECT NAME C H/LDd3/d21?1 COW-Me—, PROJECT ADDRESS D LOCUST s-r
DATE NAME/INITIALS INPECTION TYPE/NOTES STATUS
9-/O- Obi 1.Jj C. Ro. vR Lu 1‘. Zoo, dV
9-/0 -21 (ZP @Lc- Z.)uc.)v. ;oo,v. _ ._ i1 •/`/- , Ste- ic. c)IN/
ROOCA-1 OP OW tAAM4.
-/r)/aa 11% i OK
rz--02,za /0--,,0 00 tee- /M A S r ril4J / 4-4 01e
./�8 l ' ° , KOuaM FlziAmgG - R S 13 Rp OK OK
.2-/& 87 ee....0-frex
,2r e)-' 2e)N. cLt)C6 \\ .QItIL +U 0 617o ►" NA ON A3a.--, CAK
3-2Z 1/ ' . 'J 4 rllwOM ww►<k,e d./l,
-m- Rekv, F:Aq I 01, 1 IL 411:'.2.v/(:.: 4-' +0 A R-0 0 l'••• 0 \-
e/Z69 -7----
tj-22 j(,2 J,.n` '1 : L a i(
� tit U'�� �""`�'�'�? "l� (;0-�- 4- fit V 6, -
6- it
2-2 !l Jo -art->r- 3 RN s, L 4-1 v. t(
6F- -..22- , 9---j 1-7fri,.-re it- //717d.CY.3 0A.
8✓ q a). qv ►V- N`i I 1(1 3 d\ )
I i,ii, 2�,,� 5, Gt 1 C Pr+ � 37
e-12-n Y 2 0.v.
q iq zz Il, c,t. 1-z - Mott*- y a g
USE BACK SIDE FOR ADDITIONAL NOTES
PROJECT NAME PROJECT ADDRESS
DATE NAME/INITIALS INPECTION TYPE/NOTES STATUS
/0 .-)17-$ Wv\ r-,'/-01 631,14i-k_ L-It' ,,o., l '%._,,L, GI' ‘:\j Y
/o`Zs', � /-j.:",/./ Pfiencsr, / V c,,, _
iV-2�-aZ Il ►,� �ti y <oet 14-Z
.0,V__
1 k , q,7j, y.v ‘N\ 9 qqs.e.„ c"1" 200 rr% `.. .r)---.21. it 0 K
i2-i-zz )(r g Il►l' - S �r s 3 y 6 V
1— --- ii V &,
i\il0,1 u.J,th riN,,( '",, 1 j-`f o L
1-13z3 Yg rpm.. �,,,r? V 40oki 3*4 0,IC
ail--0 (6)\-\- rJ t\q ct-- 6L, Qo u
3.--2t. Pimcre-- 6 Rtivb/4 epK
331-z3 �I� frlR->a- 6 �i-k d•e
r- h,qc.t, (.0_ -'• ci-Arc' I Cil
(0_. -1-23 Q ‘i\f\
7-7-23 Jj)Q (2Hi-1-G 1. ,-,v 0,1Z
USE BACK SIDE FOR ADDITIONAL NOTES
30 LOCUST ST COMMONWEALTH OF MASSACHUSETTS EP-2021-1276
Map:Block:Lot:23B-046-
001 CTTY OF NORTHAMPTON
Permit: Elect Comm New
and Renovations
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
ELECTRICAL PERMIT
Permit# EP-2021-1276 PERMISSION IS HEREBY GRANTED TO:
2021 BIRTHING
Project# CENTER HVAC Contractor: License:
Est. Cost: WILLIAM ROBERTS ELECTRIC CO,INC 11867A
Exp.Date:08/31/202207/31/2022
Owner: COOLEY DICKINSON HOSPITAL INC
Applicant: WILLIAM ROBERTS ELECTRIC CO, INC
Applicant Address Phone: Insurance:
7 RAILROAD AVENUE (413)596-2868 6D1033520
WILBRAHAM,MA 01095
ISSUED ON: 08/3 0/2 02I
TO PERFORM THE FULL U WING WORK:
HVAC TEMP CONTROL WIRING
Call In Date: Date Requested Inspection Date/SignOff: Reinspect?:
Trench//UG:
Special Instructions
x
Rough
x
Special Instructions:
Final:
SRE Called In:
Signature:
Fees Paid: $50.00
212 Main Street,Phone(41 3)587-1244,Fa x(413)587-1272-Inspector of Wires
Ire, L2°17t ` )- ('-'4Q(1) � �
."• vt 1 • •V V• V•.r•• v--.--I i. r..aar- ems.. I,.. `mow-1�
—
MASSACHUSETTS UNIFO M APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
iTiV CITY MA DATE '// 9( PERMIT# W2421- b((,
JOBSITE ADDRESS Yotoeut T T, 1 OWNER'S NAME eockstd. ttc.x.r a-' t-( ..arc,
POWNER ADDRESS ' 04L _. ......_.. TEL 1FAX ��. _,1
N
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL!,
PRINT-
CLEARLY NEW: :__-'; RENOVATION REPLACEMENT: l PLANS SUBMITTED: YES 1 1 NOr
FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
7-- I
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM Iz. ..
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN i
FOOD DISPOSER r _.•._ ; .___
FLOOR I AREA DRAIN j
INTERCEPTOR(INTERIOR) t r ,
KITCHEN SINK
LAVATORY /3-
ROOF DRAIN PLUMBIF' G & GAS GNSPLG t t li
SHOWER STALL NORTHAMPTON
SERVICE I MOP SINK {/ AFPR,OVED NOT APPROVED -
TOILET /
URINAL
WASHING MACHINE CONNECTION 4 ,._
WATER HEATER ALL TYPES
WATER PIPING h
OTHER :Ct.cQ .11,-k5
E.
c5 �1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i;i NO 111
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1°1 OTHER TYPE OF INDEMNITY .] BOND j
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER LI AGENT P1
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in ompliance w'h II Pe ' ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i)-1-
PLUMBER'S NAME LMichael_J.Moran,Jr. 'LICENSE# M7872 1 SIGNATURE
MP;, ; JP CORPORATION[ # 1079C PARTNERSHIPg # �LLC #L
COMPANY NAME M.J.Moran, Inca _I ADDRESS 4 South Main Street J
CITY Haydenville STATE MA I ZIP 101039 TEL[413 268 7251 ii
FAX 1413-268-9375 I CELL I J EMAIL •im mlmoraninc.com
/ Z _z9
/6/ ems
A6`/cJ !� b
y` -2 1-
?3"� . -r
CH1LUI6/ 717"Cg14 .10
30 LOCUST ST COMMONWEALTH OF MASSACHUSETTS EP-2021-1578
Map:Block:Lot:23B-046-
001 CITY OF NORTHAMPTON
Permit: Elect Comm New
and Renovations
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
ELECTRICAL PERMIT
Permit# EP-2021-1578 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2020-00 154 1 Contractor: License:
Est.Cost: COLLINS ELECTRIC CO INC 12526A
Exp.Date:07/31/2022
Owner: COOLEY DICKINSON HOSPITAL INC
Applicant: COLLINS ELECTRIC CO INC
Applicant Address Phone: Insurance:
53 2ND AVE (413)592-922I 5174572
CHICOPEE,MA 01020
ISSUED ON: 12/07/2021
TO PERFORM THE FOLLOWING WORK:
RENOVATIONS TO CHILDBIRTH CENTER
Call In Date: Date Requested Inspection Date/SienOff: Reinspect?:
Trench/UG:
`Q. - c)-
Special Instructions
Ruh - (is30- al pt''r\ Tv 0 ( 3 1L(1
g 4;11\ ~1 ,:,..-, S*R (34,L\
Sped a 1 Instructions:
Final: i-1/- ) 40+-"• B', '?J D 12 r /c/ / r /t , iv i.616.6,„ 2 c awl ,Q.ra.)�., QM\I 1uo+�`
SRE Called In: / - \a 2^L., y 1-4\AAA
(e," °1' 3 ! (;!/-
Signature:
Fees Paid: S768.00
212 Main Street,Phone(413)5 8 7-1244,Fax(413)5 87-1 272-Inspector o f Wires
t (ei`Z
F „,-„t & •
r - mom 3 �'! QCQCI
�l9UM 3 a
Cry n%l-r1-t 6-ekirE� ..ir z
- t..omnwnwealth o/fl'aeeacIuiettt Official Use Only
Permit No. :20Z2-000 S
BIS2epartment of Sire Service)
H
' T31_ Occupancy and Fee Checked G Li
,- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
i All work to be performed in accordance with the Massachusetts Electrical Code(M C),52 CMR 12.00
(PLEASE PRINT IN INK OR E ALL INFORMA ION) Date: f i SO ,.Z003
City or Town of: _ To the Ins cto of Wires:
By this application the undersi ned gives notice his or her intention to perform the electrical work described below.
Location(Street& ber) 3b 19G /
Owner or Tenant Up,L c,y O/e N$o SP/77K, Telephone No.
Owner's Address
Is this permit in conjunctio N th a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building ,$P7/7' Z , Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature o�o/posed Ele callWWoork: y/C N
Completion of the folly mv
the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf T
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units —
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of
No.of Switches No.of Gas Burners No. Initiatinnggon Dete and
In Devices
No.of Ranges No.of Air Cond. of -- No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
P Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW local❑ Municipal [Ti Other
P Connectton J
No.of Dryers Heating Appliances KW 'Security Systems:*
No.of Devices or E uivale t
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices orit
No.Hydro assage Bathtubs No.of Motors Total HP lelecommumcatrons Wiring:
_ Y D �,,,,ot or A, Total
alb/ �/ �N�o.of D ices or E .alcnt
OTHE ili heie sI/J 6 �J�9' '�ry r' 1 J �/h/✓-zi L�i U 'z. -
a Attach additional detail if desired,or as r �r l/e • sr of Wires.
Estimated Value o ctri Wo ; D,//ea (When required by municipal policy. yp- i, i>40
Work to Start: / Inspebtions to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waiv by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability i ranee including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cove e is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the ins and pent(ltie perjury,that the inform do m this a placation is true and complete.
FIRM NAM '• "SC/ !� S PA)_(Ci4a7Ait�1 .NO.: Iei'
Licensee: �1 t Signature • LIC.NO.:
Address:(If applic , er,e in the license numhen�li .Q of e 70 Alt.Tel..No••1/J' 'I Kr
• *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. p(p
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent Signature Telephone No. [PERMIT v v
FEE: $5'
A Pp owiRE)
JAN 4 22
By: ........ �_
3o Locc4 s T 57—
�_ Commonweal o`IaaeactivaelLt Official Use Only
1 Permit No. rf-z o2 - —07 VT—
■ ,_, n 2epartment o` ire�erviceb
Occupancy and Fee Checked 47507D
8 ARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
CV
APPL C TION FOR PERMIT TO PERFORM ELECTRICAL WORK
Al work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRIN IN INK OR TYPE ALL INFORMATION) Date: 9/13/2 0 2 2
City, or Northampton own of: To the Inspector of Wires:
By this applicatio the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street 1Rc Number) 30 Locust St . Northampton, MA 010 60
Owner or Tenant Cooley Dickinson Hospital Telephone No.413-582-2639
Owner's Address 30 Locust St . Northampton, MA 01060
Is this permit in conjunction with a building permit? Yes ❑ air e (Check Appropriate Box)
Purpose of Building CBC RENO Utility Authorization No.
Existing Service yes Amps / 1 o w Volts OverheaE aillNo.of Meters
New Service Amps / Volts Overhead ❑ Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: pulling low volt cables for nurse call system
3 NORTH
Completion of the following table may be waived by the Inspector of Wires.
TOM
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans- Tf
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of
No.of Switches No.of Gas Burners No. Initiatinnggon Dete and
In Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
g Tons
No.of Waste Disposers Heat Pump Number ,Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
Y No.of Devices or Equivalent
No.of Water KWNo.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No. H
Y g No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $7 0, 0 0 0 (When required by municipal policy.)
Work to Start: 9/6/22 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certifj',under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Signet Electronic Systems LIC.NO.:
Licensee: Anthony Poncia Signature " O' P"eia LIC.NO.: 20309 A
(If applicable, enter "exempt"in the license number line.) Bus.Tel.No 7R1-R11-1999
Address: 90 Longwater Drive Norwell, MA 02061 Alt.Tel.Nor-
*Per M.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner [owner's agent.
Owner/Agent efdery?/aaeoaeloa 781-351-9379`PERMIT FEE: $ 886 . 56
Signature Telephone No.
✓, ✓ S�c' ��'vi/ 5 a SJn of '/'ON 1°°/ / t I 10
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
,a.El_ CITY NOrtho tr ptON MA DATE l�a ,/ ___, PERMIT#
JOBSITE ADDRESS [5O_ L p�.us-�,r� l 4 OWNER'S NAME,mil jc. ! Sry_66! c
POWNER ADDRESS _,. h.dd gi(►k G 5rer c r TEL I FAX _
TYPE OR OCCUPANCY TYPE COMMERCIAL K EDUCATIONAL RESIDENTIAL
PRINT ____
CLEARLY NEW: _ RENOVATION: REPLACEMENT: N I [ Er 1A i cl A�NS;S EMIT •D: YES _ NOI
FIXTURES 1. FLOOR--I BSM 1 2 3 4 5 el -7 8 9 10 1 12 13 14
BATHTUB J�� I MAR 4--a-':! O�Q[I i f I �- 'I I`
CROSS CONNECTION DEVICE (W �.
i
DEDICATED SPECIAL WASTE SYSTEM r_ 1_
DEDICATED GASIOIUSAND SYSTEM ( " "�.
oEo LD-;1 . nrEC. i,1Na
DEDICATED GREASE SYSTEM I_ - _- 31H4VI � ,r o o0a
DEDICATED GRAY WATER SYSTEM t >^ . M
DEDICATED WATER RECYCLE SYSTEM 1_-
1
DISHWASHER 1‘..____,
DRINKING FOUNTAIN L I 1 ... i
FOOD DISPOSER I_-.- _ i__ . 1 i . '
FLOOR/AREA DRAIN L. I -- 1 -- ( '
INTERCEPTOR(INTERIOR) L r l I i { _ i
l 1
- iP - &_cA' IN-SP r I
KITCHEN SINK L_ � ! _ 1 .
ROOF DRAIN I, _ T l A 1 I_._ l I --1---
_„
LAVATORY h
I I I i APPIOVDD "TNOTl . . . •V . _ 1"- I
SHOWER STALL i--I. ---.___. ._._._ _-- ___
SERVICE I MOP SINK 1:, -- fl E 1 I : p ,,.I✓ _ \ I. I ) - r r
TOILET (:�.__ I a. I_- 1. ._ . .._-I__. _ L. --_ 1__. L_ _.._-_ I-_-_.__ 1____ __ �_ W
URINAL I� 1 1 I I !1 _-_{�I I_ ___ _.._ I _..__ 1 ,..,,I - _
WASHING MACHINE CONNECTION I _. I_ ( I� ._
WATER HEATER ALL TYPES L_ _ I.w 11,_._ . IT IT_ 1 L_. 1 ._ __ _. _._ . . ..
WATER PIPING )_ .V _IT__. I.. ___I.__.. I -_ ( .-._-. 1. I_-_ I__
OTHER- z _ I c_ r _ ram) �I p _1T. L I
�`l# 1cAf- 4F�►fie : . II� [ .. I J I I_ '. C ' /1 I"
1_ _ n r �_,_ate _wP+�sti _ ._ . _ _ •• 1 --L ._ _ I�_ .. _ 1 I.. I- . r _-I.._.._
INSU NCE COVERAGE:
I have a current liability insurance policy or its substantial eq - alent which meets the requir ents of MGL Ch.142. YES NI NO []
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APP PR BOX BELOW
LIABILITY INSURANCE POLICY►41 OTHER TYPE OF INDEMNITY L_,I BOND El
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my si s ature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER [J_. AGENT ID
SIGNATURE OF OWNER 'iR AGENT
I hereby certify that all of the details and in •rmation I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installatio, performed under the permit issued for this application will be i ompliance with all ertinent pro 'sion of the
Massachusetts State Plumbing Code a i Chapter 142 of the General Laws.
_ LICENSE#by.13 a,_ SIGNATURE
PLUMBER'S NAME mlc.v,ael 5..�Yh�n _��S+R. __�, ____
MP® JP O CORPORATION gi#i—Iola!c,_. IPARTNERSHIPF# LLC #
COMPANY NAME 1^n-5• Man, ,nC-• [ADDRESS 9___S�ut�--y1,(4t{L .�t,I�¢,tt'� _Q1j0?Ca & �I
CITY bit& I n9 -__-, STATE i N\j W t j ZIP _ 0 5 f TEL 413-ab -l 8 as 1 i
FAX yl -2to`a-Q 15: CELLL G EMAIL ' I rv� p- 0M. ..-l �.r_C!�Y�!'1 r—._�__ _, _ _ �.m _ l